2 The technology
2.1 Apixaban (Eliquis, Bristol-Myers Squibb and Pfizer) is an anticoagulant that affects the blood coagulation cascade by directly inhibiting activated factor X (factor Xa), so inhibiting thrombin formation and the development of thrombi. Apixaban has a marketing authorisation for the 'prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective hip or knee replacement surgery'.
2.2 The recommended dosage of apixaban in the summary of product characteristics is 2.5 mg orally twice daily. The initial dose should be taken 12–24 hours after surgery. The duration of treatment depends on the individual risk of the patient for venous thromboembolism, which is determined by the type of orthopaedic surgery. Recommended treatment durations are 32–38 days for patients having hip replacement surgery and 10–14 days for patients having knee replacement surgery.
2.3 According to the summary of product characteristics, 11% of patients treated with apixaban 2.5 mg twice daily in clinical trials experienced adverse reactions. As with other anticoagulants, bleeding may occur during apixaban therapy in patients with risk factors such as lesions liable to bleed. Common adverse reactions are anaemia, haemorrhage, contusion and nausea. For full details of side effects and contraindications, see the summary of product characteristics.
2.4 Apixaban costs £17.15, £34.30 and £102.90 for packs of 10, 20 and 60 tablets respectively excluding VAT (NHS list price as reported by the manufacturer). The cost of treatment is estimated to be £41.16 (based on 12 days' treatment) for knee replacement surgery and £116.62 for hip replacement surgery (based on 34 days' treatment). Costs may vary in different settings because of negotiated procurement discounts.